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For various reasons, optimal individual therapies cannot always be derived from monitored, large-scale random studies. This applies particularly to delicate decisions on the treatment of chronically ill patients. In such situations, random, controlled and "double-blind" individual case studies with "cross-over" can be a solution. The procedure is adjusted to suit the individual patient. In many two-part treatment phases, the patient receives the active medication and an alternative/placebo. The sequence is adapted to the randomization. Neither patient nor doctor knows what the preparations are. The aims of the study are primarily oriented towards the wellbeing of the individual patient. The problems of individual optimization of therapy in practice are presented, as are the individual case study methods. Their potential application and limits and their value are discussed and illustrated by means of an actual case study.